The first state-mandated report on quality of medical care in Minnesota shows that clinics and hospitals vary dramatically in how well they treat patients -- even on something as basic as children's colds.

The report, which was two years in the making, gives consumers an inside look at how 520 individual clinics and 133 hospitals performed on a series of quality measures, from asthma to pneumonia care.

The report was mandated as part of Minnesota's 2008 health reform law and produced by the Department of Health, in an effort to place more information in consumers' hands. Although some clinics have voluntarily disclosed such information in past years, this is the first time the state required all Minnesota clinics and hospitals to participate.

"When consumers are armed with information about their health care, they will make better choices," Gov. Tim Pawlenty said in a statement. He praised the report as a market-driven, "common-sense tool for consumers that didn't come from Washington."

The report turned up some glaring gaps in the way different clinics follow what experts call "best practices." It found, for example, that certain clinics are far more likely than others to give antibiotics inappropriately to children with colds. (The recommended treatment includes rest and fluids but no antibiotics, because they don't work on cold viruses.)

The numbers also vary for diabetes care. Statewide, the percent of patients getting so-called "optimal care" ranged from 0 to 57 percent. For breast cancer prevention, some clinics report that up to 91 percent of women age 52 to 69 have had mammograms in the past two years; at others, it's as low as 55 percent.

The report, which runs for hundreds of pages, shows the extremes in each category, as well as the individual scores for all reporting clinics and hospitals.

Improve care?

Dr. Patricia Lindholm, president of the Minnesota Medical Association, said her group supports the effort to make such information public. Yet "the report reflects only a small percentage of the patient care provided," she said in a statement. She noted that a clinic's scores "are heavily influenced by factors outside of a clinic's control, such as whether or not patients choose to smoke."

Dr. Sanne Magnan, the state health commissioner, agreed. But she said this kind of public reporting can improve the quality of care by showing how clinics and hospitals compare with one another.

"Should a patient be concerned if their clinic has low scores?" she asked. "My response is a patient should look at that and ask questions. Why are the clinic scores lower?" She said studies have shown, for example, that women are eight times more likely to get mammograms if a doctor recommends it.

"For people to be healthy, it's not just what happens in the doctor's office; that's probably 20 percent," Magnan said. "But we certainly spend a lot of money there."

The report also compares Minnesota hospitals on 43 quality measures, including treatment of heart attacks, heart failure, pneumonia and other conditions.

Next year, the Health Department plans to add an interactive online component to make the report "more consumer friendly," said Katie Burns, the project director. The department also will include information about cost as well as quality in next year's report.

Eventually, health insurance plans will be required to use the information to develop incentives for patients to choose low-cost, high-performing clinics and hospitals, Burns said.

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